Waka ama: An exemplar of indigenous health promotion in Aotearoa New Zealand

Abstract Issue addressed The use of old‐style, top‐down health education and awareness programmes in Aotearoa New Zealand, which adopt a single issue‐based approach to health promotion, primarily ignores a broad approach to social determinants of health, as well as indigenous Māori understandings of wellbeing. Methods This paper draws on the indigenous framework Te Pae Māhutonga as a guide for presenting narratives collated from members of a waka ama rōpū (group) who were interviewed about the social, cultural and health benefits of waka ama. Results This waka ama case study is an exemplar of community‐led health promotion within an indigenous context, where Māori values and practices, such as whanaungatanga (the process of forming and maintaining relationships), manaakitanga (generosity and caring for others) and kaitiakitanga (guardianship), are foundational. The findings highlight the multiple benefits of engagement in waka ama and illustrate effective techniques for enhancing wellbeing within local communities. Conclusion At a time when Aotearoa New Zealand is seeing a decreasing trend in physical activity levels and an increase in mental health challenges, waka ama provides us with an exemplar of ways to increase health and wellbeing within our communities. So what? The findings of this research contribute to the evidence base of effective indigenous health promotion, bridging the gap between academia and local community action. To better recognise, comprehend and improve indigenous health and wellbeing, we argue that active participation of people in the community is required to achieve long‐term and revolutionary change.

focused on individual behaviour change strategies in spite of evidence that health is determined by wider social determinants.
As is the case with other indigenous people worldwide, M aori are disproportionately affected by lifestyle-related illnesses and continue to experience persistent health and social inequities when compared to others living in Aotearoa New Zealand. 3,4 Disparities in avoidable diseases between M aori and P akeh a (non-indigenous population of Aotearoa New Zealand) are significantly linked to broader socio-cultural/political determinants of health, such as income, housing and education. These broader variables often underpin specific behaviours that we attribute to be causative of chronic illness, such as increased alcohol, sugar, stress and inactivity. As a result of these discrepancies, current discourses hold indigenous peoples responsible for their own ill health. 3 The continuous use of traditional, top-down health education and awareness campaigns in Aotearoa New Zealand primarily ignores a broad approach to social determinants of health, as well as indigenous M aori concepts of wellbeing. 3 Indigenous M aori understandings of health are holistic, take a collectivist approach and use cultural beliefs and values to guide action. 5,6 M aori socioecological approaches, such as Te Whare Tapa Wh a, 7 Te Wheke 8  To illustrate the benefits of waka ama as an exemplar of indigenous health promotion, we use Te Pae M ahutonga, 10  Visible low in the night sky and identifying the magnetic south pole, Te Pae M ahutonga is well-known as a navigational tool and closely associated with the discovery of Aotearoa New Zealand. 9,10 Drawing on influences from Maui P omare (first M aori medical practitioner in Aotearoa New Zealand) and the Ottawa Charter, 12 Durie uses the imagery of Te Pae M ahutonga as a way to conceptualise M aori health promotion. The constellation has four central stars arranged in the shape of a cross, and two pointer stars directed towards the cross. The central stars of Te Pae M ahutonga are used to represent four key tasks of health promotion: mauriora (secure cultural identity), waiora (environmental protection), toiora (healthy lifestyles) and te Oranga (participation in society). The two stars pointing toward the cross formation represent the prerequisites for engagement, ng a Manukura (community leadership) and te Mana Whakahaere (autonomy). 9,10 This research into the social, health and cultural benefits of waka ama reminds us that it is not always top-down, service and intervention-focused approaches that our communities' benefit from the most. Rather, it encourages us to think about how we can draw upon the rich resource of m atauranga M aori (bodies of knowledge) and expertise already within our local communities. M aori terms and concepts are used throughout this article. Following each instance of a new M aori word or term, an English translation is provided, as well as a glossary provided in the Appendix.

| Philosophical approach and research design
The purpose of this qualitative case study was to explore the social, cultural and health benefits experienced by paddlers involved with a local waka ama r op u. Research design and interpretation were informed by a kaupapa M aori approach, prioritising a M aori worldview in research design and interpretation. A kaupapa M aori approach seeks to empower communities by validating local knowledge systems and experiences and by ensuring that those involved in the research gain benefits as a result. [13][14][15][16]

| Ethics
Ethical consideration for this project was informed by tikanga (M aori principles that inform practice) of the waka ama r op u and by following guidelines and procedures set out by Massey University Health and Ethics Committee (MUHEC). Cultural safety, informed consent, privacy and confidentiality issues, access to and ownership of data and how data might be used were all considered. The project was evaluated by members of the waka ama r op u and peer-reviewed by academic colleagues and was determined to be low risk. The project was recorded in the MUHEC database, Ethics Notification Number: 4000018859.

| Participants and recruitment
An established relationship between the primary researcher and Heretaunga Ararau o Ng ati Kahungunu Waka Ama R op u led to researchers being invited to attend two training sessions to meet with club members to gain more insight into the club's activities. The waka ama r op u facilitated the involvement of its members, resulting in 16 club members being interviewed kanohi ki te kanohi (face to face) at the club home base in Clive and at a local café affiliated with the waka ama r op u. Nine of these members were also involved in short interviews that were filmed for the purpose of developing a short film alongside video footage captured following two-morning training sessions. 17 Paddlers ranged in age from 35 to 65 years of age, which included seven women and nine men. Paddlers were of mixed ethnicity and experience levels, with some who were relatively new to waka ama and others who had participated for many years.

| Data collection and analysis
The researchers employed a semi-structured interview approach to facilitate the flow of conversation and allow researchers and paddlers to explore specific themes and responses in greater depth. As a topic guide, participants were asked about their motivations to join waka ama, what waka ama means to them, what changes they have noticed in themselves since starting waka ama and about the social, cultural and health benefits of being involved in waka ama. Participants provided verbal and written consent for the interviews to be recorded.
Interviews were transcribed verbatim and thematic analysis was carried out to identify, analyse and report patterns of meaning. Using topic categories relating to health and wellbeing, the transcripts were coded according to the information they contained. In this process, codes of similar nature were grouped to create concepts, and from these concepts, key themes were evaluated and further refined according to feedback from the waka ama r op u. As part of the process of identifying key themes, it was noted that they mapped well to Te Pae M ahutonga model for health promotion, and therefore we chose to structure narratives based on this framework.

| RESULTS
Based on Te Pae M ahutonga, results are presented under the four key components of health promotion, mauriora (access to te ao M aori), waiora (environmental protection), toiora (healthy lifestyle) and te oranga (participation in society) and the two pointer stars representing ng a manukura (leadership) and mana whakahaere (autonomy). A summary of the results is presented in Table 1. Benefits of waka ama.

| Mauriora: Access to te ao M aori
Mauriora refers to access to te ao M aori (M aori world) recognising the critical role of cultural identity in the health and wellbeing of a people.
Te Ao M aori is holistic and cyclical, with everything connected to everything else through whakapapa. Within this worldview, the waka is positioned as a living component of M aori people, the land and water shared and the history and traditions that each generation carries forwards. Paddlers learn and use karakia (incantations), waiata (song) and te reo (M aori language) as part of their everyday practice on the water providing a pathway for many to learn and engage in Te Ao M aori. 18 Paddlers demonstrate an understanding around waka as having their own mauri (physical vitality) and as such learn about the appropriate language and protocols to follow to respect the waka, the environment and their fellow paddlers. These efforts have led to an increased number of members in the r op u becoming aware of the importance of tikanga with many going on to expand their knowledge of te reo and m atauranga M aori through courses at the local w ananga (tertiary institute).
(It's) a way into tikanga, which is not sort of academic or heady. It's just about participation and about doing things (Male paddler).
We always have a karakia before we go for a paddle. And just through like respecting the waka as entities. It's not just a boat, you know. It's an entity. It has a gender and requires due respect to be shown to it. You know, the Waka ama also helps to create a safe space for experiential learning and partnership between M aori and non-M aori providing an opportunity for P akeh a New Zealanders to discover and enhance their own sense of identity relative to M aori culture. P akeh a paddlers discussed how waka ama provides a gateway into te ao M aori that normalises M aori culture demonstrating ways te ao M aori can be incorporated into their daily activities.
It's been a learning curve for me.

| Waiora (environmental protection)
Waiora reflects how our health and wellbeing as a people are con- It's really helped me… we have lived here for quite a few years, but somehow being on the water and being connected to the river, seeing it in that way, it's really helped me be in a relationship with this land and place more deeply. (Female paddler).
As a task for health promotion, waiora places a strong emphasis on environmental protection. It is about finding mutually beneficial ways to engage with the environment which maintain and preserve natural integrity and resources for the benefit of ensuing generations.
Waka ama helps fosters a reciprocal relationship between paddlers and the environment, encouraging individuals to recognise their role as kaitiaki (guardians) in caring for the environment that nourishes them.
A lot of people that are into waka ama are also very much into protecting these waterways or fixing them or getting change to happen, because they are in direct contact with them… and to me that's a real M aori thing, you know everything is connected to the land, connected to the water, and so that part I really value as well. (Male paddler).

| Toiora (healthy lifestyles)
Toiora is about facilitating healthy lifestyles. Within a te ao M aori per- Paddlers also spoke of the importance of having a positive, strength-based approach to wellbeing within the r op u. They hold collective aspirations on their journeys to become healthier together.
This allows them to realise their aspirations as a group. For many members, it has given them a focus and provided opportunities to realise their potential by competing together at regional, national and international levels. In a wh anau atmosphere, their participation has fostered a strong sense of kotahitanga (unity) and manaakitanga (generosity and caring for others), teaching participants a sense of collective responsibility and commitment towards their r op u: Being able to train as a team together, has been fantastic,

| Te Oranga (participation in society)
Te Oranga is about fostering inclusion and participation in society. It is about making space for community voices to be heard and acted Water activities like waka ama support the principle of waiora by providing opportunities for participants to immerse themselves in the environment. Understanding the interdependence of environmental and human health is a core concept in te ao M aori and research has shown that engaging with nature is beneficial to overall health and wellbeing. 10,26,27 This interdependence relates to the idea that the mauri of the environment has an effect on the mauri of the people and vice versa. 8,26 There are a number of variables that have a negative impact on health and wellbeing, including pollution, depletion of natural resources and the loss of land. 28 Living in cities can also promote detachment and a lack of appreciation for the natural environment. Participation in activities like waka ama helps connect people with their natural surroundings, which can lead to positive changes in how they interact and view their relationships with the environment.
Having direct contact with water increases environmental awareness and motivation for waka ama members to participate in environmental protection activities, ultimately leading to improved health and wellbeing for both people and the environment.
Waka ama is a healthy, fun, intergenerational activity incorporating a number of healthy lifestyle benefits that link both physical and spiritual dimensions of wellbeing. This is consistent with the principle of toiora, which emphasises opportunities to promote healthy lifestyles. 9 promotion initiatives is critical to the long-term viability of these programmes since it is through this process of community participation that culturally relevant and meaningful programmes are created. In addition, we believe that long-term success requires flax root leadership, such as that generated through waka ama.
This may necessitate some health practitioners to abandon established notions of authority to consider strategies to best support the intrinsic health potential of their communities. This requires a strong commitment to building relationships and working with and on behalf of the communities in which health practitioners are involved, and considering the promotion of health holistically instead of focusing on narrowly defined issue-based health promotion. In addition, this approach has implications for funding models, which tend to favour the implementation of individual behaviour change strategies on a national scale over developing capacities at a localised community level. Improving responsiveness to local priorities will require a better understanding of how funding mechanisms can better support community-based health promotion. Overall, to better recognise, comprehend and improve indigenous health and wellbeing, this article advocates for indigenous knowledge to be more fully integrated within health promotion which can be achieved through using frameworks such as Te Pae M ahutonga.